Anti-Obesity Medications: An Update for Canadian Physicians

Main Article Content

Renuca Modi
Rameez Kabani
Jerry Dang
Sarah Chapelsky
Arya Sharma

Abstract

Objective
To review for Canadian physicians the latest pharmacological options for obesity management.


Quality of Evidence
A literature search was conducted in PubMed with no time restriction. Canadian and international guidelines referenced. National and international statistics databases quoted for epidemiological data. Levels of evidence range from I to III.


Main Message
As a chronic progressive disease affecting over 7.2 million Canadians, obesity requires early identification and treatment by primary care practitioners. Three anti-obesity medications are approved for use in Canada under the tradenames Xenical®, Saxenda®, and Contrave® which help bridge the gap between non-pharmacological and surgical options for the treatment of obesity. Family physicians are front-line members of the obesity management team and should remain updated on the pharmacological options for weight management.


Conclusion
Anti-obesity medications lead to greater average weight loss when combined with behavior modifications and provide individuals with excess weight a sustainable option for obesity management.


RESUME
Objectif
Examiner, à l’intention des médecins canadiens, les dernières options pharmacologiques pour la gestion de l’obésité.


Qualité des preuves
Une recherche documentaire a été effectuée dans PubMed sans restriction de temps. Les lignes directrices canadiennes et internationales sont référencées. Bases de données statistiques nationales et internationales citées pour les données épidémiologiques. Les niveaux de preuve vont de I à III.


Message principal


En tant que maladie chronique progressive touchant plus de 7,2 millions de Canadiens, l’obésité nécessite un dépistage et un traitement précoces par les praticiens de soins primaires. Trois médicaments contre l’obésité sont approuvés au Canada sous les noms commerciaux Xenical®, Saxenda® et Contrave®, qui aident à combler le fossé entre les options non pharmacologiques et chirurgicales pour le traitement de l’obésité. Les médecins de famille sont des membres de première ligne de l’équipe de gestion de l’obésité et doivent se tenir au courant des options pharmacologiques pour la gestion du poids.



Conclusion
Les médicaments contre l’obésité entraînent une perte de poids moyenne plus importante lorsqu’ils sont associés à des modifications du comportement et offrent aux personnes en surpoids une option durable pour la gestion de l’obésité.

Abstract 386 | pdf Downloads 236 html Downloads 230

References

1. Statistics Canada. Canadian community health survey. Body mass index, overweight or obese, self-reported, adult, age groups (18 years and older). 2017 [cited 2018 Sept 04].
2. cma.ca [Internet]. Canada: CMA recognizes obesity as a disease; c2018 [cited 2018 Jul 25]. Available from: https://www.cma.ca/En/Pages/cma-recognizes-obesity-as-a-disease.aspx
3. Katzmarzyk PT, Ardern CI. Overweight and obesity mortality trends in Canada, 1985–2000. Can J Public Health. 2004;95(1):16–20. http://dx.doi.org/10.1007/BF03403627
4. Puhl RM, Suh Y. Health consequences of weight stigma: Implications for obesity prevention and treatment. Curr Obes Rep. 2015;4(2):182–90. http://dx.doi.org/10.1007/s13679-015-0153-z
5. Kahan S, Puhl RM. The damaging effects of weight bias internalization. Obesity. 2017;25(2):280–1. http://dx.doi.org/10.1002/oby.21772
6. Lau D, Douketis J, Morrison K, Hramiak I, Sharma A, Ur E. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. CMAJ. 2007;176(8):S1–13. http://dx.doi.org/10.1503/cmaj.061409
7. obesitycanada.ca [Internet]. Canada: Report card on access to obesity treatment for adults in Canada; c2018 [cited 2018 Jun 26]. Available from: https://obesitycanada.ca/publications/canadians-lack-access-obesity-treatments-support-report-card/
8. James WP, Caterson ID, Coutinho W, Finer N, Van Gaal LF, Maggioni AP, et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. NEJM. 2010;363(10):905–17. http://dx.doi.org/10.1056/NEJMoa1003114
9. Davidson M, Hauptman, J, DiGirolamo, M, Foreyt, J, Halsted, C, Heber, D, et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: A randomized controlled trial. JAMA. 1999;281:235–42. http://dx.doi.org/10.1001/jama.281.3.235
10. Wharton S. Current perspectives on long-term obesity pharmacotherapy. Can J Diabetes. 2016;40(2):184–91. http://dx.doi.org/10.1016/j.jcjd.2015.07.005
11. Naltrexone. Product monograph. Toronto, ON: Teva Canada Limited; 2015.
12. Bupropion Hydrochloride (Wellbutrin). Product monograph. Laval, QC: Valeant Canada LP; 2017.
13. Bupropion Hydrochloride (Zyban). Product monograph. Laval, QC: Valeant Canada LP; 2016.
14. Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. NEJM. 2016;375(4):311–22. http://dx.doi.org/10.1056/NEJMoa1603827
15. Nissen SE, Wolski KE, Prcela L, Wadden T, Buse JB, Bakris G, et al. Effect of naltrexone-bupropion on major adverse cardiovascular events in overweight and obese patients with cardiovascular risk factors: A randomized clinical trial. JAMA. 2016;315(10):990–1004. http://dx.doi.org/10.1001/jama.2016.1558
16. Volkow ND, Wang GJ, Tomasi D, Baler RD. Obesity and addiction: Neurobiological overlaps. Obes Rev. 2013;14(1):2–18. http://dx.doi.org/10.1111/j.1467-789X.2012.01031.x
17. Volkow ND, Wang GJ, Baler RD. Reward, dopamine and the control of food intake: Implications for obesity. Trends Cogn Sci. 2011;15(1):37–46. http://dx.doi.org/10.1016/j.tics.2010.11.001
18. Saxenda. Product monograph. Mississauga, ON: Novo Nordisk Canada Inc.; 2017.
19. Contrave. Product monograph. Laval, QC: Valeant Canada LP; 2018.
20. Wadden TA, Hollander P, Klein S, Niswender K, Woo V, Hale PM, et al. Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: The SCALE maintenance randomized study. Int J Obes (Lond). 2013;37(11):1443–51. http://dx.doi.org/10.1038/ijo.2013.120
21. le Roux CW, Astrup A, Fujioka K, Greenway F, Lau DC, Van Gaal L, et al. 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: A randomised, double-blind trial. Lancet. 2017;389(10077):1399–409. http://dx.doi.org/10.1016/S0140-6736(17)30069-7
22. Davies MJ, Bergenstal R, Bode B, Kushner RF, Lewin A, Skjoth TV, et al. Efficacy of liraglutide for weight loss among patients with type 2 diabetes: The SCALE diabetes randomized clinical trial. JAMA. 2015;314(7):687–99. http://dx.doi.org/10.1001/jama.2015.9676
23. Blackman A, Foster GD, Zammit G, Rosenberg R, Aronne L, Wadden T, et al. Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: The SCALE Sleep Apnea randomized clinical trial. Int J Obes (Lond). 2016;40(8):1310–19. http://dx.doi.org/10.1038/ijo.2016.52
24. Greenway FL, Fujioka K, Plodkowski RA, Mudaliar S, Guttadauria M, Erickson J, et al. Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): A multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2010;376(9741):595–605. http://dx.doi.org/10.1016/S0140-6736(10)60888-4
25. Apovian CM, Aronne L, Rubino D, Still C, Wyatt H, Burns C, et al. A randomized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity-related risk factors (COR-II). Obesity (Silver Spring). 2013;21(5):935–43. http://dx.doi.org/10.1002/oby.20309
26. Wadden TA, Foreyt JP, Foster GD, Hill JO, Klein S, O’Neil PM, et al. Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: The COR-BMOD trial. Obesity (Silver Spring). 2011;19(1):110–20. http://dx.doi.org/10.1038/oby.2010.147
27. Hollander P, Gupta AK, Plodkowski R, Greenway F, Bays H, Burns C, et al. Effects of naltrexone sustained-release/bupropion sustained-release combination therapy on body weight and glycemic parameters in overweight and obese patients with type 2 diabetes. Diabetes Care. 2013;36(12):4022–9. http://dx.doi.org/10.2337/dc13-0234
28. Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, et al. Pharmacological management of obesity: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342–62. http://dx.doi.org/10.1210/jc.2014-3415
29. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: A systematic review and meta-analysis. JAMA. 2016;315(22):2424–34. http://dx.doi.org/10.1001/jama.2016.7602
30. Wadden TA, Berkowitz RI, Sarwer DB, Prus-Wisniewski R, Steinberg C. Benefits of lifestyle modification in the pharmacological treatment of obesity: A randomized trial. Arch Intern Med. 2001;161(2):218–27. http://dx.doi.org/10.1001/archinte.161.2.218
31. Xenical. Product monograph. Mississauga, ON: Hoffmann-La Roche Limited; 2015.